Nitric oxide versus epoprostenol for refractory hypoxemia in Covid-19.

OBJECTIVE: To compare the efficacy and outcomes with inhaled nitric oxide (iNO) and inhaled epoprostenol (iEPO) in patients with refractory hypoxemia due to COVID-19. DESIGN: Retrospective Cohort Study. SETTING: Single health system multicenter academic teaching hospitals. PATIENTS OR SUBJECTS: Age group of 18-80 years admitted to the medical ICU. INTERVENTIONS: Mechanically ventilated patients with COVID-19 infection, who received either iNO or iEPO between March 1st, 2020, and June 30th, 2020. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the change in the PaO2/FiO2 (P/F) ratio 1 hour after initiation of pulmonary vasodilator therapy. Secondary outcomes include P/F ratios on days 1-3 after initiation, positive response in P/F ratio (increase of at least 20% in PaO2), total days of treatment, rebound hypoxemia (if there was a drop in oxygen saturation after treatment was stopped), ventilator free days (if any patient was extubated), days in ICU, days to extubation, days to tracheostomy, mortality days after intubation, 30-day survival and mortality. 183 patients were excluded, as they received both iNO and iEPO. Of the remaining 103 patients, 62 received iEPO and 41 received iNO. The severity of ARDS was similar in both groups. Change in P/F ratio at one hour was 116 (70.3) with iNO and 107 (57.6) with iEPO (Mean/SD). Twenty-two (53.7%) patients in the iNO group and 25 (40.3%) in the iEPO group were responders to pulmonary vasodilators n(%)(p = 0.152) (more than 20% increase in partial pressure of oxygen, Pao2), and 18 (43.9%) and 31 (50%) patients in the iNO and iEPO group (p = 0.685), respectively, had rebound hypoxemia. Only 7 patients in the cohort achieved ventilator free days (3 in the iEPO group and 4 in iNO group). CONCLUSIONS: We found no significant difference between iNO and iEPO in terms of change in P/F ratio, duration of mechanical ventilation, ICU, in-hospital mortality in this cohort of mechanically ventilated patients with COVID-19. Larger, prospective studies are necessary to validate these results.

Hemorrhagic PRES: A Rare Neurological Manifestation of COVID -19 Infection

As of August 2021, the COVID -19 pandemic has affected approximately 200 million cases worldwide. Most of the reported medical literature about the COVID-19 infection discusses its respiratory and haematological manifestations, with limited information about its neurological complications. Encephalitis, meningitis, acute disseminated encephalomyelitis, stroke and encephalopathy have been reported in patients with COVID-19 infection. Symptomatology of CNS involvement includes dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizures. Encephalopathy is encountered commonly in patients with severe disease, multi-organ dysfunction and elevated inflammatory markers. Acute cerebrovascular disease is another major manifestation of COVID -19 infection and is mainly due to occlusion of large vessels, hypercoagulability and a pro-inflammatory state. In this report, we discuss the diagnosis and outcome of a 30-year-old patient detected with Posterior Reversible Encephalopathy Syndrome (PRES) as a complication of COVID-19 infection. We hope this report will provide physicians with a useful framework for understanding pathophysiology and imaging findings of PRES in COVID-19 infection. © 2022 Journal of Association of Physicians of India. All rights reserved.

Cyberbullying in Online/E-Learning Platforms Based on Social Networks

Cyberbullying is a method of harassment using electronic means and is very common among all, as the digital sphere has extended its technology. As school districts shut down in retort to COVID-19 and students are moving to E-learning, ever than before our children may be using most of the period in front of screens. Though the digital world is supporting us link and study more, it is also a situation where harmful behavior can be encountered. It is serious that we engross our children in dialogue to keep them protective and motivate them to be very vigilant with what they share online. To better safeguard your child, we wish you to study more about digital awareness, check your child’s screen time and online activities, comprehend and set settings related to privacy, and set rules with your child. Bullying is spiteful behavior that is aggressive, unwanted, and repeated. This can be verbal, social, physical, or online. They are acts of power and can directly cause guilt, sadness, shame, and anger. Bullying is not restricted to children;adults can also bully other adults or children. Cyberbullying is victimization that happens online and over digital devices. Cyberbullying examples comprise detestable or mean texts, social media posts envisioned to embarrassing or fake images, spread rumors, sexually explicit, or threatening direct messages. It is significant to take cyberbullying and bullying of any kind, seriously. Bullying can have a long-lasting effect on a child’s mental health, relationships, and confidence. It can distress their capability to focus on academics and extracurricular happenings. And, it can also cause a child to make to bullying others, as a technique to get control back and feel like they have power again. In social media where bigger communication opportunities are offered, they even enhance the defenselessness for many people in the form of threatening online with the messages, images, and so on. In recent studies, cyberbullying constitutes a growing problem among youngsters, teenagers, and school students. To avoid such situation, an intelligent system is required for the identification of these threats automatically. The chapter mainly focuses on the types of cyberbullying, followed by case studies in which we discuss about the automatic detection of cyberbullying in online learning/E-learning platform based on social network. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.